D'Orazio Joseph L, Curtis John A
Department of Emergency Medicine, Division of Medical Toxicology, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA.
J Emerg Med. 2011 Aug;41(2):172-5. doi: 10.1016/j.jemermed.2009.10.030. Epub 2010 Apr 24.
Drug abuse is a common problem in the United States. Drugs can be acquired in many ways, and can be knowingly or mistakenly misrepresented when sold. Propafenone is an uncommonly encountered class IC antidysrhythmic that is a look-alike for the opioid, oxycodone/acetaminophen 5/325.
We report a case of propafenone overdose presenting with generalized tonic-clonic seizure and a widened QRS complex, occurring after the patient had reported ingesting "Percocet®" (Endo Pharmaceuticals, Chadds Ford, PA).
A 17-year-old boy presented to the emergency department (ED) after a witnessed seizure lasting 2 min. The patient reported having ingested 6 "Percocet®" tablets that he purchased from a classmate. He noted feeling weak and dizzy approximately 3 h after the ingestion, just before the seizure. On arrival in the ED, the patient was awake and alert with a QRS length of 168 ms. A sodium bicarbonate bolus and infusion shortened the QRS length to 90 ms. The patient was discharged the following day with no further complications. The pills were identified as propafenone hydrochloride (HCl) 225-mg tablets. The classmate surreptitiously sold the pills as "Percocet®" due to their similar "512" imprint.
Pharmaceutical drugs are often sold on the street, and often misrepresented. Propafenone HCl 225-mg is an uncommonly encountered pharmaceutical, but is a look-alike for oxycodone/acetaminophen 5/325. An overdose due to propafenone ingestion may present with seizures and a widened QRS complex.
药物滥用在美国是一个常见问题。药物有多种获取途径，销售时可能会被有意或无意地误认。普罗帕酮是一种较少见的ⅠC类抗心律失常药物，其外观与阿片类药物羟考酮/对乙酰氨基酚5/325相似。
我们报告一例普罗帕酮过量病例，患者在自述服用“羟考酮控释片”（Endo制药公司，宾夕法尼亚州查兹福德）后出现全身强直阵挛性发作和QRS波群增宽。
一名17岁男孩在目睹其癫痫发作持续2分钟后被送往急诊科。患者自述服用了从同学处购买的6片“羟考酮控释片”。他提到服药后约3小时，即在癫痫发作前感到虚弱和头晕。到达急诊科时，患者清醒且警觉，QRS波群时长为168毫秒。静脉推注和输注碳酸氢钠后，QRS波群时长缩短至90毫秒。患者次日出院，无进一步并发症。这些药片被鉴定为225毫克盐酸普罗帕酮片。由于药片上有相似的“512”印记，该同学将其偷偷当作“羟考酮控释片”出售。
药品经常在街头售卖，且常被误认。225毫克盐酸普罗帕酮是一种少见的药品，但外观与羟考酮/对乙酰氨基酚5/325相似。普罗帕酮摄入过量可能导致癫痫发作和QRS波群增宽。
